Aims and Objectives: This study aimed to perform a systematic review of all the available published data on CRC in Nigerians over a period of 53years as a proximate indication of the burden of the disease. Materials & Methods: The data were sourced from PubMed, MEDLINE, EMBASE and Google Scholar search engines as well as direct contact with some authors. All published studies on histologically confirmed CRC in Nigerians constitute the materials. Selected papers were independently reviewed by the authors. Results: Of 35 papers found, 19 met the criteria and a total of 2497 cases reported in these 19 publications constituted the materials utilised for the review. There is increasing incidence as evident by increase in annual frequency increased from 18.2/annum in the early years (1954-1969) to 86.8/annum in the latter years (1991-2007). The average age incidence was 46years (peak=41-50 age group); 674(32%) of all the cases were aged below 40years. The male to female ratio was .3:1. Of the 2238 cases in which site was reported, rectum 1349(60%) was the commonest site followed by caecum 260(17%). All the cases were adenocarcino- mas and 1043(56%) were well differentiated. Mucinous carcinoma and signet ring type accounted for 309(17%) and 32(2%) respectively. Of 1061 cases in which Duke's staging was reported, 622(59%) presented in stage B disease fol- lowed by stage C 266(25%). Conclusions: The incidence is of CRC is increasing in Nigeria. The mean age is low and incidence appears to be increasing in younger patients.

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Aims and Objectives: . This is a review of the initial experience with surgical management of upper cervical spine injuries. Materials and Methods: The clinical case notes of patients surgically managed for UCSI were analysed for aetiology, presentation, duration of symptoms before presentation and surgery, pre- and post-operative Frankel grading, nature of injury and type of surgery. Results: Eleven male and one female patients (mean age; 41.8 years; range 22-58 years) with UCSI were managed surgically. All the patients were involved in road traffic crashes. The case distribution were odontoid peg fracture [type II] alone (2 cases), hangman fracture alone (5 cases), both C1/2 subluxation and odontoid peg fracture (4 cases) and complex C2 injury (1 case). The surgical management includes C1 posterior ring excision and occipitocervical fusion [C0 - C4] (one patient), modified Gallie fusion alone (six patients), combined modified Gallie fusion and Rogers interspinous wiring (three patients). One patient each had C1/C2 interspinous wiring and combined modified Gallie fusion and occipito-cervical fusion [C0 - C4]. Post-operatively, two patients improved from Frankel C to D, 2 patients from C to E and one patient from D to E. The other patients with Frankel D and E injuries pre-operatively remained in status quo post-operatively. Eleven of the patients were discharged home on progressive ambulation with one having neck stiffness and one patient died 7 weeks post- surgery. Conclusion: Odontoid peg and hangman fractures were the most common indications for upper cervical spine surgery for trauma in our unit, and the post- operative outcome appears satisfactory.

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Aims and objectives: The objective of this study is to describe the pattern of missed injuries in trauma associated mortalities in the University College Hospital Ibadan Nigeria and to determine the relevance of postmortem examination in trauma related death. Subjects and methods: All cases of trauma- associated death in the Accident and Emergency Department of the University College Hospital (UCH), Ibadan Nigeria over a ten year period from January 1997 to December 2006 were reviewed. Data extracted from the records included the demographic data, the mechanism of injury, time and duration of injury prior to presentation and the clinical diagnosis. The autopsy findings were compared to the clinical diagnosis by the medical officer in the emergency department. The unrecorded injuries noted at autopsy were reviewed and classified using the modified Goldman criteria for autopsy discrepancies Results: Two hundred and ninety trauma related autopsies were performed within the stipulated period. Diagnostic errors were observed in fifty five (18.9%) of these autopsies. The commonest mechanism of injury was road traffic accident (73%). Thirty (57%) of these patients arrived at the ED within six hours of injury. There were 79 missed injuries consisting of chest injuries (43%), while 26% were abdominal injuries. There were 25 type1 and 25 type 2 major errors. The mean revised trauma score (RTS) at presentation was 4.81+/_ 1.9 with a probability of survival of >60% Conclusion Trauma care needs to be taught as a specialty. Post mortem remains a necessary quality control tool.

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Aims and Objectives: The aim of this study was to compare the duration of postoperative analgesia and possible adverse effects produced by caudal bupivacaine 0.25% at 1 ml/kg with or without 1.5 µg/kg of neostigmine in children undergoing unilateral herniotomy. Patients and Methods: Sixty-six children aged 1-6 years, of ASA physical status classes I or II for elective unilateral herniotomy under general anaesthesia without premedication were studied. The patients were randomly allocated into two groups of 33 each. Group B received caudal analgesia with plain bupivacaine 0.25% at 1ml/kg alone, while group BN received caudal analgesia using a mixture of plain bupivacaine 0.25% at 1ml/kg and neostigmine 1.5 µg/ kg. Postoperatively, monitoring of pain scores and time to first analgesic request and, total dose of analgesics administered in the first 24 hours were recorded. Results: All the patients participated throughout the study. There were no differences in the demographic characteristics (age, weight, ASA status)between the two groups. The mean duration of effective analgesia was significantly longer in group BN, 460±60.2 min. compared to group B, 286.4±47.8 mins, (p < 0.001). The analgesic requirement within the first 24 hours postoperatively was also significantly reduced in group BN, p < 0.001. Conclusion: The study shows that the addition of low dose neostigmine to caudal isobaric bupivacaine significantly prolonged the time to first analgesicrequest and hence significantly reduced postoperative analgesic requirement

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Aim and Objectives : This study was carried out to assess the blood donation practices and willingness to donate among residents of an urban slum. Material and Methods : Cross sectional descriptive study design with a qualitative and quantitative component. Multistage sampling was used to select 400 respondents for the questionnaire interview while three FGD sessions were conducted guide among three groups of participants namely youths, men and women. The information collected was analyzed manually (FGD) and with Epi info version 3.5.3 Results : Majority of the questionnaire respondents were female, married, traders, had at least secondary school education, with mean age of 37.6years. Only 12.0% had donated in the past, the main reason given by non donors was that they had never been asked to donate; this was also a key finding in the FGD. Willingness to donate was positively associated with being a male, single and Christian, age was a significant predictor of previous donation while more of the previous donors were still willing to donate, more for family/friends (p=0.036) than voluntarily (p=0.001) this view was supported by the participants at the FGD. Conclusion : Members of this urban slum had poor practice of blood donation,had positive attitude and were willing to donate, there is need to mobilise and organise outreach blood donation programs to convert attitude into actual practice.

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Aims and objectives: To document the pattern of bone malignancies in a highly populated orthopaedic hospital in Lagos Nigeria; Patients and methods: A total of 21 cases of primary malignant bone tumours were studied. This comprised 12 cases of Osteosarcoma, 7 cases of Malignant Fibrous Histiocytoma (MFH) and 2 cases of Chondrosarcoma. Males (13) were affected more than females (8) giving a male to female ratio of 1.6 to 1. The age range was 7 to 45 years with a median age of 24 years. The diameter of the swelling ranged from 6 to 20cm with a median of 12cm. All patients had ablative surgery except for those with affectation of the ilium. Data was analysed using the Statistical Package for Social Sciences (SPSS 16). Enneking's classification was used to grade the tumour. duration of symptoms of all the patients before presentation ranged from 3 weeks to 4 years with a mean of 7 months. The commonest site affected was around the knee (76.2%); distal femur had 42.9% and proximal tibia 33.3%. Results: Osteosarcoma was the most common malignant bone tumour in this series and accounted for 57.1%. The peak incidence was found in the 2nd decade of life. The youngest patient was 7 years old and the oldest 43 years. The tumour was found primarily around the knee. 7 cases were in the distal part of the femur, in the proximal part of the tibia and 1 case was found in the distal radius. Out of the 12 patients with osteosarcoma, 8 had paraosteal type (5 high grade, 3 intermediate grade), the remaining 4 had periosteal (all high grade) Malignant Fibrous Histiocytoma was found in 7 patients and accounted for 33.3%. The peak incidence was found in 3rd and 4th decades. 4 out of the 7 patients were high grade pleomorphic osteosarcoma, 2 were myxoid high grade dedifferenti- ated and one was low grade giant cell tumour type. Chondrosarcoma was found in 2 patients, accounting for 9.5%. both cases were in the ilium Conclusion: Primary malignant bone tumours occurred in children and young adult in this study. It is commoner among males and most of the patients presented late to the hospital. Osteosarcoma is the commonest followed by Malignant Fi- brous Histiocytoma, both occurred commonly around the knee and chondrosar- coma on the ilium.

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Aims and Objectives: To give a report of 36 consecutive children who underwent laparoscopic Anderson-Hynes dismembered pyeloplasty by a single lead sur- geon. Patients and Methods: The diagnosis of pelviureteric junction obstruction was firmly established in all patients based on history, clinical examination, renal sonography and scintigraphy. Transperitoneal laparoscopic Anderson-Hynes pyeloplasty was performed in all the patients. Age at surgery, duration of opera- tion, complications and outcome were documented. Children were followed up for symptoms, and diuretics renography was repeated at 3 months. Results: A total of 36 children 5 months to 11 years (25 boys and 11girls) under- went laparoscopic Anderson- Hynes pyeloplasty over a 4- year period. Mean age at surgery was 41 months (range 7 to 144). Seventeen (47%) cases were antenatally diagnosed. The mean operating time was 247min. No patient required blood transfusion, and there were no intra-operative complications. The mean postop- erative hospital stay was 5.8days. There were 7 postoperative complications including urinary tract infection (n=6) and shoulder pain (n=1). The symptoms improved in 32(89%) children. There were 3 conversions, 2 due to non rotated kidney and one due to double right moiety. One child had failed pyeloplasty with deteriorating renal function. He had a redo open pyeloplasty. The mean split renal function before surgery and at follow up diuretic scan was 36.2 vs 42.1, P=0.001. The mean follow up period was 30months. Conclusion: Laparoscopic Anderson-Hynes pyeloplasty is safe and effective in the management of children with pelvi-ureteric junction obstruction.

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Aims and Objectives Flour dust has been associated with lung function impairment and Chronic Obstructive Airway Disease (COAD) among grain workers. This study was therefore conducted to assess the lung function indices of flour mill workers in Edo and Delta states, of Nigeria. Materials and Methods Comparative cross-sectionalstudy designed was utilized for the study and it was carried out over a period of six months, (Nov 2010 to May 2011) among 200 flour mill workers and 200 hospital workers in Edo and Delta states.A modified Medical Research Council (MRC) questionnaire which was interviewer administered and an electronic hand held spirometer was used to collect data. Data analysis was carried out using Statistical Package for Scientific Solution (SPSS) version 17. Results : The Peak Expiratory Flow Rate (PEFR) of the flour dust exposed workers was significantly lower (p<0.001) compared to that of the unexposed population. All other lung function parameters were also lower although not statistically significant. Conclusion: Flour dust exposed workers in Edo Delta states like grain workers elsewhere have lung impairment, hence the need to provide protective equipment and also carry out regular periodic medical checks.

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Aims and Objectives: The study assessed awareness and attitudes of people working in the environment (users) of the motor parks (but not travelers), in a sub-urban town to environmental noise and its hazards. Subjects and methods: Regular users of major motor parks in Sagamu were administered with pretested structured questionnaire to obtain information on their awareness and attitudes concerning noise and NIHL at the parks. Descriptive and comparative analysis of the data obtained was performed by using SPSS version 15.0. Results: Data from 387 subjects were analysed; 61.2% were males, mean age was 35.5 11.4 years, 56.8% had secondary school education, and 50.6% were vehicle drivers or conductors. 51.2% ascribed vehicular traffic the major source of noise generation at the parks, while average noise level was 84.1΁6.0dBA. Among the subjects, 61.2% approved motor park was noisy, 47.8% (185/387) were aware of NIHL. Awareness did not change with age and sex, but increased significantly with level of education. 51.9% were concerned about the noisy environment, 12.7% (49/387) protected themselves from the effect of the noise, 6.1% used earplugs. Attitudes of the users did not change with age, sex, and level of education. Conclusions: Noise level at the motor parks were marginally high, awareness of the users to noise and its hazards was relatively high but attitudes concerning protection from noise hazards was poor. Health education for the users and noise regulation at the parks were recommended.

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Aims and objectives : This study aimed to evaluate the March 2010 edition of the regular biannual two-week course on health resources management organised by the National Postgraduate Medical College of Nigeria. The main objectives were to assess participants' perception of the course and to measure change in their knowledge brought about by the course. Subjects and Methods : This is a primarily cross-sectional study but with a before and after component. The study population comprised all participants who attended the course. Data were collected using pre-tested structured self- administered questionnaires. Data analysis was done with Epi Info 3.5.1. Student's T-test was used to compare mean scores at pre-test and post-test and the p-value of <0.05 was considered statistically significant. Results : Majority (95.8%) of the participants were senior registrars from teaching hospitals and most of them (70.5%) claimed the course met their needs a great deal/to a large extent. The participants were satisfied to a varying degree with different aspects of the course but overall 50.9% claimed they got value for their money. There was a statistically significant difference in the knowledge score at pre- and post-test (t = 3.19, p = 0.002). Conclusion : The course met the needs of the participants largely and was able to improve their knowledge of health resources management as intended. A behaviour evaluation is recommended in order to assess the usefulness of the course to participants' practice.

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Aims and Objectives: The aim was to identify any relationship between obesity and peripheral arterial disease (PAD) in diabetic subjects. Subjects and methods : Male and female diabetic subjects aged 50-89 years. Body mass index (BMI) was used to estimate total body weight and the waist-to- hip ratio (WHR) as well as waist circumference (WC) were used for abdominal fat distribution estimation. Peripheral arterial disease was defined by an ankle brachial index <0.9. Results : Peripheral arterial disease (PAD) was observed in 52.5% of the subjects. BMI, WHR and WC did not correlate with PAD. Conclusion : None of the parameters (i.e BMI, WHR and WC) used to assess the relationship between obesity and PAD was found to correlate with PAD.

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A report of two cases of cerebral atrophy and dementia possibly arising as a result of poor control of type 2 Diabetes Mellitus are presented. The two elderly patients presented to the old age Psychiatric clinic with history of impairment in memory and changes in personality. They had a history of long standing poorly controlled diabetes mellitus. They were assessed using psychometric instruments, laboratory investigation and neuro-imaging. A diagnosis of dementia was made in each of two the patients. The aim of this case report is to draw the attention of the medical community and policy makers to the relationship between type 2 diabetes mellitus and dementia with a view to evolving policy change on the care for the elderly in Nigeria.

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Aims and Objectives: This study was undertaken to determine the prevalence of hepatitis C virus antibodies (anti- HCV) among transfused patients with haematological disorders. and correlate this with the units of blood or blood products received Patients and Methods : This was a cross sectional study. Patients with haematological disorders who had received two or more units of blood or blood products and healthy blood donors who had not received blood transfusion were screened for ant-HCV using Enzyme Linked Immunosorbent Assay (ELISA) kits. Results : A total of 480 subjects comprising 146 patients with haematological disorders and 334 blood donor controls were recruited for this study. The patients comprised 78 (53.4%) males and 68 (46.6%) females with age range from 14-65 years and a mean of 39.5. The prevalence of anti-HCV was 6 (4.1%) among transfused patients and7 (2.1%) among untransfused blood donors. The risk of anti- HCV positivity among patients was higher with increasing units of received blood or blood products. A significant statistical association was observed between the number of pints of blood or blood products received and anti-HCV positivity among patients p=0.008 Conclusion : This study suggests that patients who had received blood or blood products are at higher risk of HCV infection than the untransfused individuals. The risk of infection is higher with increasing units of blood or blood products received by transfused patients.

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Aims and Objectives : This study is aimed at determining the knowledge of Paediatricians in Nigeria about the basic principle of radiation protection ALARA (As Low As Reasonably Achievable) and their knowledge of the radiation doses that children receive during some common radiological procedures. Materials and methods : Two hundred and fifty questionnaires were circulated among paediatricians at the 2012 annual Paediatricians' Association of Nigeria Conference. The questionnaires contain 10 questions designed to asses the pediatricians' general knowledge on : ionising radiation and the risks, doses children receive during some common radiological procedures and awareness of the radiation protection principle, ALARA ( As Low As Reasonably Achievable). Results : Of the162 Paediatrcians that participated, 69% named at least one non medical source of ionising radiation, 54.9% would not recommend CXR to screen an apparently healthy child for tuberculosis and 87% believe that children are at greater risk of adverse effects of ionising radiation. For dose estimation, 51.9% and 51.2% of the paediatricians underestimated doses received during Cranial and abdominal computerised tomography respectively while 13.6% and 37% respectively erroneously believed that abdominal ultrasound and brain magnetic resonance imaging utilise ionising radiation. 13.6% gave the correct meaning of the Acronym ALARA. Conclusions : The Paediatricians' knowledge about the basic principle of radiation protection ALARA and the doses that children receive during some common radiological procedures is poor. There is need to ensure adequate training on radiation hazards and protection at all levels of medical education.

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Aims and Objectives: The objective was to evaluate obstetric and neonatal outcomes in booked grandmultiparas (para e"5) and compare with outcome in age and social status matched booked multiparas (para 2-4) after eliminating confounders. Patients and Methods : A cohort study with grandmultiparas (subjects) and age and social status matched multiparas as controls. All participants were counseled and an informed consent obtained at the antenatal clinic. Maternal demography and history were taken; they were subsequently monitored during pregnancy, labour and immediate puerperium. The main outcome measures were obstetric and neonatal outcomes among subjects and controls. Results : The incidence of grandmultiparity was 4.1%. During antenatal period, grandmultiparas had statistically significantly higher occurrence of late antenatal booking (P=0.0202), anaemia (P=0.0024) and past history of poor perinatal outcome (P=0.0124). Grandmultiparas had statistically significant occurrence of preterm delivery (P=0.0389) and higher but not statistically significant mean duration of labour (P=0.3532), intrapartum complications (P=0.2014) and postpartum haemorrhage (P=0.2126). Neonates of grandmultiparas had statistically significant low first minute Apgar scores (P=0.0011) with higher but not statistically significant occurrence of low birth weight (P=0.1613) and neonatal intensive care admission (P=0.7202). The perinatal mortality rates were 136 and 75 per 1 000 deliveries for grandmultiparas and multiparas. There were no maternal deaths during the study period. Conclusion : After controlling for age and social class, booked grandmultiparas had poorer obstetric and neonatal outcome compared to booked multiparas but these were majorly statistically insignificant due to effect of modern antenatal care

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Extradural arachnoid cysts develop from protrusions of arachnoid herniating through a dural defect. Solitary lesions are more common than multiple lesions. This report is an uncommon multiple spinal extradural arachnoid cysts, illustrating the value of magnetic resonance imaging in the diagnosis. 42-year-old man presented with low back pain radiating into the left leg with associated paraesthesia. Magnetic resonance images showed two well defined expansile lobulated collections. These lesions expanded the spinal canal, appearing as both hyperintense and hypointense on T1 and T2 sequences respectively. The lesions were resected and the dorsal communicating channel was closed. He had remarkable pain reduction thereafter.

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Optical Coherence Tomography produces high resolution tomographic in in vivo imaging of biological tissues. The study reviews OCT images of two patients with varied retinal pathologies to determine its usefulness in aiding evaluation and management of retinal diseases. The patients were imaged using OCT, conventional fundus photography and angiography. A case each of premacular haemorrhage and idiopathic polypoidal choroidal vasculopathy, are presented highlighting the merits of OCT. OCT establishes the accurate diagnosis of retinal diseases and in monitoring response to therapy. It is complementary to clinical techniques of direct and indirect ophthalmoscopy, conventional fundus photography, fluorescein and indocyanine green angiography thus should be made readily available for use in the evaluation of retinal disorders to enhance their management.

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